Vanderbilt University School of Medicine

Patel, Mayur B. , MD, MPH
Assistant Professor of Surgery
Assistant Professor of Neurological Surgery

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Phone Number: 615-875-5843


Patel, Mayur's picture

Office Address   Mailing Address

1211 21st Avenue South; 404 Medical Arts Building; Nashville, TN 37212

1211 21st Avenue South; 404 Medical Arts Building; Nashville, TN 37212

Research Keywords
Traumatic Brain Injury, Sympathetic Hyperactivity, Agitation, Severe TBI, TBI, Catecholamines, Heart rate variability, Adrenergic alpha-Agonists, Adrenergic beta-Antagonists, Cognitive Impairment

Research Specialty
Traumatic Brain Injury

Clinical Research Description
I am an Assistant Professor of Surgery in the Department of Surgery and Division of Trauma & Critical Care. My current research interests focus on severe traumatic brain injury, and associated sympathetic hyperactivity and long-term cognitive dysfunction.

In developed countries, traumatic brain injury (TBI) is the leading cause of death and disability among young adults. Annually in the US, TBI affects more than 2 million individuals with an economic impact of $76.5 billion, and hospitalized severe TBI patients account for 90% of this cost. Severe TBI, defined using a Glasgow Coma Scale (GCS) score >= 8, often leads to a state of sympathetic hyperactivity, manifesting as hypertension, tachycardia, abnormal autonomic function, and agitation.

Persistent sympathetic hyperactivity after severe TBI is a harbinger of bad clinical outcomes that include more days of mechanical ventilation, longer intensive care unit (ICU) lengths of stay, and poor neurologic function. A few small studies have shown that beta-blockers and alpha-2 agonists (adrenergic blockers) may confer some beneficial effects in severe TBI patients and has led to their increased empiric usage. Yet, no study has systematically evaluated the safety and efficacy of adrenergic blockade in TBI patients whose injured brains are particularly sensitive to hypotension.

I am leading a double-blinded, randomized, placebo-controlled pilot trial in a 100 patient cohort in which one group will receive centrally acting sympatholytic drugs, propranolol and clonidine, and the other group, placebo, within 48 hours of severe TBI. The length of therapy will be 7 days.

This trial is short-titled the DASH After TBI Study. The official title is Decreasing Adrenergic or Sympathetic Hyperactivity After Severe Traumatic Brain Injury, A Pilot Randomized Clinical Trial Using Propranolol and Clonidine. For more information about this trial, see

The primary question for the DASH After TBI Study is whether adrenergic blockade after severe TBI will be associated with improved short-term clinical outcomes such as increased ventilator-free days (primary outcome) and lower agitation scores. Secondary endpoints include plasma and urine catecholamine levels, heart rate and blood pressure variability, responses to autonomic cold pressor testing, assessments of coma, sedation, and agitation, sedative requirements, analgesic use, antipsychotic medication use, coma-free days, Intensive Care Unit (ICU) length of stay, and survival. Also, neuropsychological and quality of life outcomes will be measured at ICU discharge, 3 months, and 12 months.

For more details of my work or for my CV, please contact me.

Clinical Interests
Traumatic Brain Injury, Sympathetic Hyperactivity, Agitation, Severe TBI, TBI, Catecholamines, Heart rate variability, Adrenergic alpha-Agonists, Adrenergic beta-Antagonists, Cognitive Impairment

Patel, MB, Humble, SS, Cullinane, DC, Day, MA, Jawa, RS, Devin, CJ, Delozier, MS, Smith, LM, Smith, MA, Capella, JM, Long, AM, Cheng, JS, Leath, TC, Falck-Ytter, Y, Haut, ER, Como, JJ. Cervical spine collar clearance in the obtunded adult blunt trauma patient: A systematic review and practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg, 78(2), 430-41, 2015.

Patel, MB, Morandi, A, Pandharipande, PP. What''s new in post-ICU cognitive impairment. Intensive Care Med, , , 2015.

Patel, MB, Wilson, LD, Bregman, JA, Leath, TC, Humble, SS, Davidson, MA, de Riesthal, MR, Guillamondegui, OD. Neurologic Functional and Quality of Life Outcomes after TBI: Clinic Attendees Versus Non-Attendees. J Neurotrauma, , , 2015.

Pandharipande, PP, Patel, MB, Barr, J. Management of pain, agitation, and delirium in critically ill patients. Pol Arch Med Wewn, 124(3), 114-23, 2014.

Patel, MB, Laudanski, K, Pandharipande, PP. An international career development survey of critical care practitioners*. Crit Care Med, 42(4), e300-3, 2014.

Andersen, ND, Bhattacharya, SD, Williams, JB, Fosbol, EL, Lockhart, EL, Patel, MB, Gaca, JG, Welsby, IJ, Hughes, GC. Intraoperative Use of Low-Dose Recombinant Activated Factor VII During Thoracic Aortic Operations. Ann Thorac Surg, , , 2012.

Hughes, CG, Patel, MB, Pandharipande, PP. Pathophysiology of acute brain dysfunction: what''s the cause of all this confusion. Curr Opin Crit Care, , , 2012.

Patel, MB, Guillamondegui, OD, May, AK, Diaz, JJ. Twenty-year analysis of surgical resident operative trauma experiences. J Surg Res, , , 2012.

Patel, MB, Guillamondegui, OD, Ott, MM, Palmiter, KA, May, AK. O'' Surgery Case Log Data, Where Art Thou. J Am Coll Surg, , , 2012.

Patel, MB, High, K, Eckert, M. Tension pneumoperitoneum after traumatic gastric rupture. Am Surg, 78(9), E435-6, 2012.

Patel, MB, McKenna, JW, Alvarez, JM, Sugiura, A, Jenkins, JM, Guillamondegui, OD, Pandharipande, PP. Decreasing adrenergic or sympathetic hyperactivity after severe traumatic brain injury using propranolol and clonidine (DASH After TBI Study): study protocol for a randomized controlled trial. Trials, 13, 177, 2012.

Webb, LH, Patel, MB, Dortch, MJ, Miller, RS, Gunter, OL, Collier, BR. Use of a furosemide drip does not improve earlier primary fascial closure in the open abdomen. J Emerg Trauma Shock, 5(2), 126-30, 2012.

Coursey, CA, Nelson, RC, Moreno, RD, Patel, MB, Beam, CA, Vaslef, S. Appendicitis, Body Mass Index, and CT: Is CT More Valuable for Obese Patients than Thin Patients. Am Surg, 77(4), 471-5, 2011.

Coursey, CA, Nelson, RC, Moreno, RD, Dodd, LG, Patel, MB, Vaslef, S. Carcinoid tumors of the appendix: are these tumors identifiable prospectively on preoperative CT. Am Surg, 76(3), 273-5, 2010. PMCID:2941610

Coursey, CA, Nelson, RC, Patel, MB, Cochran, C, Dodd, LG, Delong, DM, Beam, CA, Vaslef, S. Making the diagnosis of acute appendicitis: do more preoperative CT scans mean fewer negative appendectomies? A 10-year study. Radiology, 254(2), 460-8, 2010. PMCID:2941610

Kim, CY, Patel, MB, Miller, MJ, Suhocki, PV, Balius, A, Smith, TP. Gastrostomy-to-gastrojejunostomy tube conversion: impact of the method of original gastrostomy tube placement. J Vasc Interv Radiol, 21(7), 1031-7, 2010. PMCID:2941610

Garrigues, GE, Patel, MB, Colletti, TP, Weaver, JP, Mallon, WJ. Thrombosis of the brachial artery after closed dislocation of the elbow. J Bone Joint Surg Br, 91(8), 1097-9, 2009.

Geng, Q, Romero, J, Saini, V, Patel, MB, Majetschak, M. Extracellular 20S proteasomes accumulate in packed red blood cell units. Vox Sang, 97(3), 273-4, 2009. PMCID:2776309

Manning, EW, Patel, MB, Garcia-Covarrubias, L, Rahnemai-Azar, AA, Pham, SM, Majetschak, M. Proteasome peptidase activities parallel histomorphological and functional consequences of ischemia-reperfusion injury in the lung. Exp Lung Res, 35(4), 284-95, 2009.

Funk, DJ, Lujan, E, Moretti, EW, Davies, J, Young, CC, Patel, MB, Vaslef, SN. A brief report: the use of high-frequency oscillatory ventilation for severe pulmonary contusion. J Trauma, 65(2), 390-5, 2008.

Majetschak, M, Patel, MB, Sorell, LT, Liotta, C, Li, S, Pham, SM. Cardiac proteasome dysfunction during cold ischemic storage and reperfusion in a murine heart transplantation model. Biochem Biophys Res Commun, 365(4), 882-8, 2008.

Majetschak, M, Zedler, S, Hostmann, A, Sorell, LT, Patel, MB, Novar, LT, Kraft, R, Habib, F, de Moya, MA, Ertel, W, Faist, E, Schade, U. Systemic ubiquitin release after blunt trauma and burns: association with injury severity, posttraumatic complications, and survival. J Trauma, 64(3), 586-96; discussion 596-8, 2008.

Patel, MB, Earle, SA, Majetschak, M. Dynamics of tissue ubiquitin pools and ubiquitin-proteasome pathway component activities during the systemic response to traumatic shock. Physiol Res, 56(5), 547-57, 2007.

Patel, MB, Majetschak, M. Distribution and interrelationship of ubiquitin proteasome pathway component activities and ubiquitin pools in various porcine tissues. Physiol Res, 56(3), 341-50, 2007.

Patel, MB, Nathan, JD, Frush, DP, Rice, HE. Nonoperative management of asymptomatic traumatic pulmonary hernia in a young child. J Trauma, 62(1), 234-5, 2007.

Earle, SA, El-Haddad, A, Patel, MB, Ruiz, P, Pham, SM, Majetschak, M. Prolongation of skin graft survival by exogenous ubiquitin. Transplantation, 82(11), 1544-6, 2006.

King, DR, Patel, MB, Feinstein, AJ, Earle, SA, Topp, RF, Proctor, KG. Simulation training for a mass casualty incident: two-year experience at the Army Trauma Training Center. J Trauma, 61(4), 943-8, 2006.

Patel, MB, Feinstein, AJ, Saenz, AD, Majetschak, M, Proctor, KG. Prehospital HBOC-201 after traumatic brain injury and hemorrhagic shock in swine. J Trauma, 61(1), 46-56, 2006.

Patel, MB, Proctor, KG, Majetschak, M. Extracellular ubiquitin increases in packed red blood cell units during storage. J Surg Res, 135(2), 226-32, 2006.

Burleigh, ME, Babaev, VR, Patel, MB, Crews, BC, Remmel, RP, Morrow, JD, Oates, JA, Marnett, LJ, Fazio, S, Linton, MF. Inhibition of cyclooxygenase with indomethacin phenethylamide reduces atherosclerosis in apoE-null mice. Biochem Pharmacol, 70(3), 334-42, 2005.

Earle, SA, Proctor, KG, Patel, MB, Majetschak, M. Ubiquitin reduces fluid shifts after traumatic brain injury. Surgery, 138(3), 431-8, 2005.

Feinstein, AJ, Patel, MB, Sanui, M, Cohn, SM, Majetschak, M, Proctor, KG. Resuscitation with pressors after traumatic brain injury. J Am Coll Surg, 201(4), 536-45, 2005.

Babaev, VR, Patel, MB, Semenkovich, CF, Fazio, S, Linton, MF. Macrophage lipoprotein lipase promotes foam cell formation and atherosclerosis in low density lipoprotein receptor-deficient mice. J Biol Chem, 275(34), 26293-9, 2000.

Segal, BH, Sakamoto, N, Patel, M, Maemura, K, Klein, AS, Holland, SM, Bulkley, GB. Xanthine oxidase contributes to host defense against Burkholderia cepacia in the p47(phox-/-) mouse model of chronic granulomatous disease. Infect Immun, 68(4), 2374-8, 2000. PMCID:97432

Yamakawa, Y, Takano, M, Patel, M, Tien, N, Takada, T, Bulkley, GB. Interaction of platelet activating factor, reactive oxygen species generated by xanthine oxidase, and leukocytes in the generation of hepatic injury after shock/resuscitation. Ann Surg, 231(3), 387-98, 2000. PMCID:1421010

Wilkins, KB, Sheikh, E, Green, R, Patel, M, George, S, Takano, M, Diener-West, M, Welsh, J, Howard, S, Askin, F, Bulkley, GB. Clinical and pathologic predictors of survival in patients with thymoma. Ann Surg, 230(4), 562-72; discussion 572-4, 1999. PMCID:1420905

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